In an animal model of drug idiosyncrasy, rats cotreated with nonhepatotoxic doses of lipopolysaccharide (LPS) and ranitidine (RAN) develop hepatocellular injury, whereas rats treated with LPS and famotidine (FAM) do not. The coagulation system and neutrophils (PMNs) are requisite mediators of LPS/RANinduced liver injury. We tested the hypothesis that unique gene expression in LPS/RAN-treated rats requires coagulation system activation and that these changes are absent in rats given LPS and FAM. Rats were treated with a nonhepatotoxic dose of LPS (44.4 ϫ 10 6 endotoxin units/kg i.v.) or its vehicle, and then 1 h later, they were treated with heparin (3000 U/kg) or its vehicle. One hour thereafter, they were given RAN (30 mg/kg), FAM (6 mg/kg, a pharmacologically equiefficacious dose, or 28.8 mg/kg, an equimolar dose), or vehicle (i.v.). They were killed 2 or 6 h after drug treatment for evaluation of hepatotoxicity, coagulation system activation, and liver gene expression (2 h only). Statistical filtering of gene array results and real-time polymerase chain reaction identified groups of genes expressed in LPS/RAN-treated rats but not LPS/FAM-treated rats that were either changed or unchanged by heparin administration. For example, LPS/RAN-induced mRNA expression of the inflammatory mediators interleukin-6, cyclooxygenase-2, and macrophage inflammatory protein-2 (MIP-2) was reduced by anticoagulation. Enhancement of serum MIP-2 and plasminogen activator inhibitor-1 concentrations in LPS/RAN-treated rats was prevented by anticoagulation. The results suggest cross-talk between hemostasis-induced gene expression and inflammation (e.g., PMN function) in the genesis of hepatocellular injury in LPS/RAN-treated rats. In contrast, neither the expression of such genes nor hepatocellular necrosis occurred in rats treated with LPS/FAM.Idiosyncratic drug reactions are adverse responses that occur in a small fraction of people taking a drug, and the liver is a frequent target organ. The unpredictable nature and severity of idiosyncratic liver injury have significant impact both on human health and the pharmaceutical industry. Although numerous studies have proposed that idiosyncratic hepatotoxicity occurs as a consequence of metabolic polymorphism and/or drug-specific immunity (for reviews, see Pirmohamed et al., 1996;Ju and Uetrecht, 2002), for the majority of drugs, the mechanisms underlying idiosyncratic responses are unclear. Recent studies have suggested that an inflammatory response might precipitate idiosyncratic liver injury from some drugs, and animal models have been developed to examine drug-inflammation interaction (Buchweitz et al., 2002;Luyendyk et al., 2003b;Roth et al., 2003).The histamine2 (H2)-receptor antagonist ranitidine (RAN)