Inflammatory diseases favour the onset of venous thromboembolic events in hospitalized
patients. Thromboprophylaxis with a fixed dose of heparin/low molecular weight heparin (LMWH)
is recommended if concomitant inflammatory disease. In severe acute respiratory syndrome
coronavirus 2 (SARS-CoV2) pneumonia an inflammation-dependent thrombotic process occurs and
platelet activation may promote thrombosis and amplify inflammation, as indicated by previous
experimental evidence , and the similarities with atherothrombosis and thrombotic
microangiopathies. Antiplatelet agents represent the cornerstone in the prevention and
treatment of atherosclerotic arterial thromboembolism, with limited efficacy in the context
of venous thromboembolism. The use of purinergic receptor P2Y12 inhibitors in pneumococcal
pneumonia may improve inflammation and respiratory function in humans. There are no validated
protocols for thrombosis prevention in Covid-19. There is scientific rationale to consider a
P2Y12 inhibitor for the prevention of thrombosis in the pulmonary circulation and attenuation
of inflammation. This is supported by numerous demonstrations of the anti-inflammatory
activity of P2Y12 inhibitors and the evidence of improvement in respiratory function both in
human and experimental pathology. Prasugrel could be considered as an ideal candidate drug
for Covid-19 patients because of higher efficacy and limited Interactions with drugs used in
the treatment of Sars-CoV2. The hypothesis underlying the present study project is that in
Covid-19 platelet activation occurs through an inflammation-dependent mechanism and that
early antithrombotic prophylaxis in non-critical patients could reduce the incidence of
pulmonary thrombosis and respiratory and multi-organ failure improving clinical outcome in
patients with SARS-CoV2 pneumonia. The prevention of thrombogenic platelet activity with a
P2Y12 inhibitor could be superior to fixed dose enoxaparin alone. The proposed treatment is
feasible in all coronavirus disease 2019 (COVID-19) patients, regardless of the treatment
regimen (antivirals, anti-inflammatory drugs, antibiotics), except for specific
contraindications.