The (very) new patterns.meta
library allows for easier ways of specifying patterns and in particular allows a transformation to be applied to the pattern tiles.
It is still under development (there is no documentation yet), only supports PDF output, and is only available in the latest CVS version but is more-or-less stable (so you have been warned).
\documentclass[tikz,border=5]{standalone}
\usetikzlibrary{patterns.meta}
\tikzdeclarepattern{name=Stars,
type=uncolored,
tile bounding box={(-5pt,-5pt) and (5pt,5pt)},
tiling size={(\tikztilesize, \tikztilesize)},
parameters={\tikzstarpoints,\tikzstarradius,\tikzstarrotate,\tikztilesize},
tiling transformation={rotate=\tikzstarrotate},
keys={
points/.store count=\tikzstarpoints, points=5,
radius/.store length=\tikzstarradius, radius=3pt,
rotate/.set macro=\tikzstarrotate, rotate=0,
tile size/.store length=\tikztilesize, tile size=10pt
},
code={
\pgfmathparse{180/\tikzstarpoints}\let\a=\pgfmathresult
\fill (90:\tikzstarradius) \foreach \i in {1,...,\tikzstarpoints}{
-- (90+2*\i*\a-\a:\tikzstarradius/2) -- (90+2*\i*\a:\tikzstarradius)
} -- cycle;
}
}
\begin{document}
\begin{tikzpicture}
\draw [pattern=Stars, pattern color=blue] (0,0) rectangle ++(2,2);
\draw [pattern={Stars[points=7, tile size=15pt]}] (2,0) rectangle ++(2,2);
\draw [pattern={Stars[rotate=45]}, pattern color=red] (0,2) rectangle ++(2,2);
\draw [pattern={Stars[rotate=30,points=4,radius=5]}] (2,2) rectangle ++(2,2);
\end{tikzpicture}
\end{document}