When a route is async, it gets scheduled on the main event loop, meaning that any blocking calls can block all requests in flight, and block unexpected things like start up and teardown of api handlers. `asyncio.to_thread()` can help here, but it's easy to forget (and there's no warnings in case you forget).
If you do mix the two, I would be very careful to monitor the timings of your requests to detect early if blocking is occurring. For adding these metrics, I suggest using something like statsd or open-telemetry libraries for adding reporting to the endpoints, which you can feed into telemetry dashboards.
If you're forced to use a slower sync function (say, something from a library that you can't easily change), then you can use asyncio.to_thread() so that it can run in a separate thread without blocking your main event loop. If you don't do that, then you sort of defeat the whole purpose of the architecture because everything would stop while you're waiting for that slow sync function to return.