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The role of epidural analgesia for trauma patients has expanded in recent years, and concurrently, clinicians have made substantial advancements in post-injury venous thromboembolism (VTE) prevention. Early chemoprophylaxis has proven safe and effective for most trauma patients, even those classically considered high risk for VTE chemoprophylaxis.1 Though different regimens have been rigorously tested, it has been shown that two times a day enoxaparin is the superior regimen for prophylaxis in trauma patients,2 and missed prophylactic doses significantly increase the risk of VTE.3 Unfortunately, at present, modern VTE prevention strategies misalign with the American Society of Regional Anesthesia and Pain Medicine’s (ASRA) fourth edition of its Evidence-Based Guidelines, which caution against the use of two times a day enoxaparin while an epidural is in place.4 Though well-intended, ASRA’s warnings have likely resulted in an overabundance of caution that prevents one complication while increasing the risk of another, and as trauma surgeons, we feel this merits further discussion.