A patient on warfarin presents for a dental extraction with an INR of 3.8. What is the most appropriate course of action?

An INR of 3.8 is above the typically accepted threshold for routine dental extractions. Most guidelines consider extraction safe when INR is up to 3.0 to 3.5 with local hemostatic measures. At INR 3.8, the risk of post-extraction bleeding increases. The appropriate management is to refer to the prescribing physician (typically a cardiologist, hematologist, or internist) to discuss whether the warfarin dose can be temporarily adjusted or whether the extraction can proceed safely. Independent reduction of warfarin by the dentist without physician consultation is inappropriate, as it may increase the risk of thromboembolic events in patients who need anticoagulation.