patternTransform

html,
body,
svg {
  height: 100%;
}

<svg viewBox="0 0 100 100" xmlns="http://www.w3.org/2000/svg">
  <!-- Apply a transform on the tile -->
  <pattern
    id="p1"
    width=".25"
    height=".25"
    patternTransform="rotate(20)
                      skewX(30)
                      scale(1 0.5)">
    <circle cx="10" cy="10" r="10" />
  </pattern>

  <!-- Apply the transformed pattern tile -->
  <rect x="10" y="10" width="80" height="80" fill="url(#p1)" />
</svg>