We read with great interest the article by Vincent et al.1 We commend the authors for their innovative methodology with longitudinal approach to demonstrate acquired antithrombin deficiency in injury and poor responsiveness to enoxaparin and its association with venous thromboembolism (VTE). This article1 adds to recent literature that recognizes key pitfalls in a universal approach to prevention of trauma-related VTE in contrast to a personalized approach to identify anticoagulant resistance and/or nonresponsiveness to optimize therapy.2,3