Which of the following is NOT a component of the Well's Criteria for DVT assessment?

• A. Active cancer
• B. Paralysis, paresis, or recent plaster immobilization of the LE
• C. Alternative diagnosis as likely or greater than that of proximal DVT
• D. Abnormal D-dimer level

Answer: (D)

Wells criteria quantify pretest probability of DVT using clinical features that raise risk and a deduction for cases where another diagnosis is more likely. Active cancer and paralysis/immobilization of the leg are factors that add points because they increase the likelihood of DVT. If the clinician judges that an alternative diagnosis is as likely or more likely than proximal DVT, a negative point is applied, lowering the overall probability. D-dimer, meanwhile, is a separate laboratory test used to help rule out DVT after applying the Wells assessment or when probability is low; it is not a component of the Wells scoring itself. A normal D-dimer can rule out DVT in low-probability patients, while an abnormal result needs further imaging and does not by itself confirm DVT. Therefore, abnormal D-dimer level is not part of the Wells criteria.