v4 has the same external API as v3, but significantly changed internals. Plugin authors should update their packages.
External API did not change.
markdown-it with plugins - make sure to update those.token = state.push(type, tag, nesting). See this commit to understand how to create tokens in new way. Also see changes in plugins from other repos in this org..validateUrl() -> moved to root class .validateLink().normalizeLink() & .normalizeLinkText() to root class, and removed normalizeUrl() from utils.replaceEntities() in utils.