The novel amphiphilic acylated dextran-g-polytetrahydrofuran (AcyDex-g-PTHF) graft copolymers have been successfully synthesized via combination of living cationic ring-opening polymerization of tetrahydrofuran (THF) to prepare living PTHF chains with different molecular weights (Mn, PTHF) of 800–2800 g/mol with nucleophile substitution to mediate grafting numbers (GN) of 4–25 per 1000 Dex monosaccharide. The microphase separation in the graft copolymer exists for the incompatibility of hard dextran backbone and soft PTHF branches and the confined crystallization of backbone. This copolymer behaves excellent hemocompatibility with red blood cells, good biocompatibility with HeLa cells and strong resistance to bovine serum albumin adsorption. The microspheres (~1 μm) of graft copolymers loaded with drug ibuprofen exhibit pH sensitive controlled drug release behavior. Moreover, the AcyDex-g-PTHF/Ag nanocomposites show good antibacterial property against E. coli and S. aureus. This novel hemocompatible, biocompatible and antifouling AcyDex-g-PTHF graft copolymer will have potential application in biological and medical fields.